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NSCLC Flashcards

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1
Q

maintenance therapy

A

only indicated for bevacizumab and pemetrexed, hasn’t been shown for taxol in SCC

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2
Q

ALK

A

ALK (ch2) with EML4 ch5–> do not confer increased sensitivity to chemo–> occur in never/light smokers, adenos, younger age; not associated with ethnicity or sex. 40% positive in never-smoker EGFR wild type

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3
Q

pulmonary reserve

A

FVC<1L contraindicated

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4
Q

post-op RT

A

only if N2 involvement, can consider stage IB

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5
Q

stage 3 N0 disease

A

surgery, postop chemo if positive nodes in path

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6
Q

nonbulky N2 disease (one node 1-2cm)

A

neoadj chemorad–>surg

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7
Q

small cell treatment

A

limited stage: cis/carbo+etop+RT

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8
Q

mesothelioma treatment

A

if EPP–>chemo–>RT

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9
Q

platinum doublets superiority

A

all similar with median survivals of 8 months

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10
Q

second line therapy docetaxel

A

improved OS compared to BSC Shepard JCO 2000

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11
Q

pemetexed second line

A

Hanna- pemetrexed v. docetaxel, non-inferiority, better tolerated; limited to non-SCC

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12
Q

recurrent disease approved

A

doce, erlotinib, pemetrexed

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13
Q

two v. three drugs NSCLC

A

no clear advantage for third cytotoxic, or targeted to doublet

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14
Q

bevicizumab benefit

A

improved survival with carbo/taxol in non-squamous, E4599 Sandler NEJM 2006

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15
Q

bev with what backbone?

A

no OS benefit in combination with cis/gem (AVAIL trial), but still approved in variety of regimens. give with carbo/taxol

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16
Q

beva side effects

A

enhanced toxicity of standard cytotoxic- neuropathy, neutropenia, posterior leukoencephalopathy syndrome, tracheoesophageal fistula, HTN, thrombosis

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17
Q

bevacizumab contra

A

hemoptysis, anticoagulation, etc.

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18
Q

adenoca epi

A

least associated with tobacco, but most still tobacco associated

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19
Q

pem for SCC

A

cis/gem v. cis/pem for SCC–> non-SCC did better with pem

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20
Q

EGFR mutation epidemiology

A

Asians, never smokers, younger

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21
Q

ALK translocation

A

5% unselected Adeno, treat with crizotinib

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22
Q

ROS1 mutation

A

response to crizotinib

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23
Q

EGFR mutant

A

erlotinib or afatinib

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24
Q

erlotinib in non-EGFR mutant

A

FDA approved, might be a board answer in second-third line setting

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25
maintenance tx
only for non-SCC, pemetrexed (switch or continuation); continuation maintenance is acceptable (E4599 data)
26
maintenance targeted therapy
erlotinib can be an option even in a non-selected patients
27
number of doses of doublet
only 4-6 cycles max, more not better with doublet, then thats all the benefit
28
ECOG 3-4 patients
do not benefit from cytotoxic therapy
29
elderly treatment
only based on PS, not chronologic age
30
locally advanced unresectable disease
RT AND chemo: concurrent if possible
31
chemoRT regimens
similar outcomes: cis/etop/RT v. carbo/taxol/RT-->carbo/taxol
32
for resected NSCLC, chemo
either neoadjuvant or adjuvant, predomin adjuvant
33
LACE trial
lung adjuvant cisplatin eval: meta-analysis: chemo decreases lung death by 6.9%
34
PS2 patients adjuvant
better without chemo in adjuvant setting! in metastatic, give carbo-based instead of cis-based
35
adjuvant benefit
more with stage III (NNT 8) ,stage II (NNT 10), stage IB (NNT 33)
36
neoadjuvant chemotherapy
not predominant standard of care, boards questions based on adjuvant
37
first line metastatic NSCLC
median survival 8 months for any doublet
38
second line NSCLC
pemetrexed and docetaxel similar OS, pemetrexed better tolerated.
39
bevacizumab for NSCLC
in NON-Squamous, PCB>PC had improved OS (2 month improvement). the benefit is only with carbo/taxol
40
bevacizumab tox
bleeding ,clotting, HTN, proteinuria, dehiscence, increased neuropathy/neutropenia with chemo, tracheoesophageal fistula-->do not give with chemoradiotherapy, PLES (posterior leukoencephalopathy)
41
anticoagulants and bev for NSCLC
generally avoided but not absolute contraindication
42
SCC NSCLC and bev
no! pulmonary hemorrhage in 31% of pts treated (severe or fatal)
43
cis/gem/bev for NSCLC
NO! bev didn't improve outcome in this combination
44
NSCLC SCC metastatic treatment versus non-SCC
squamous-gem; adeno-pem
45
pemetrexed for NSCLC
only for non-squamous! (pem-adeno)
46
erlotinib metastatic
acceptable treatment for wild type for boards
47
ramicurimab
anti-VEGFR2 antibody that improved survival (1.4mo) in recurrent NSCLC with docetaxel (doce+ramicurimab v. doc)
48
nivolumab for NSCLC
second line SCC approval compared to docetaxel--> OS 9.2 v 6mo
49
how many cycles for first line NSCLC?
6 cycles max (4-6 okay) even if tolerating well. can consider maintenance
50
PFS for NSCLC
if ECOG 3,4 , then no chemotherapy. ECOG 3: >50% in bed
51
NSCLC lung genetics
Kras 25%, EGFR 17%, ALK 8%, HER2 3%, BRAF 2%, PI3K 1%, MET 1% RET 1%
52
EGFR mutation
response rate high if mutant (gefitnib, erlotinib). activating mutations
53
crizotinib indications
ALK mutant (but some benefit in ROS mutation even though not on FDA label)
54
ceritinib for NSCLC
second generation ALK inhibitor, benefit even after crizotinib progression
55
SCC mutations NSCLC
FGFR amp, PTEN mutation, PTEN los, PIK3CA mutation, DDR2 mutation
56
switch or continuation maintenance therapy for NSCLC
benefit only for non-squamous- PFS to switching to pemetrexed after platinum doublet, can continue bevacizumab
57
resistant EGFR mutations
T790M, D761Y
58
unresectable NSCLC
chemoradiation (cis/etop/RT or carbo/taxol/RT)
59
large cell neuroendocrine cancer
treat by default as an adenocarcinoma NSCLC, or you can treat based on what it looks like (could look like small cell)
60
neoadjuvant therapy NSCLC
theoretical reason for benefit- better delivery of chemo prior to surgery, better tolerated, measure of response,
61
erlotinib flare
can have growth of cancer with stopping. give erlotinib all the way up to chemo
62
NSCLC Stage IB Dx and Tx
3-5cm. surgery, consider RT.
63
Adjuvant NSCLC chemo
ONLY CIS-based (cis/vino or cis/etop)--> 5% abs benefit
64
Stage IIIa non-bulky definition
no or small N2 (mediastin/carinal) clinically (one node)
65
Stage IIIa non-bulky management
resectable--> give surgery-->adj chemo and RT, or chemorad-->surgery, or NA chemo-->surgy
66
Stage IIIa bulky (cN2+) or IIIb
usually unresectable: Tx is chemoRT (cis/etop/RT best, or carbo/taxol/RT-->carbo/taxol)
67
Pancoast tumor defn and tx
superior sulcus--> Horner syndrome - ptosis, miosis, and anhidrosis) + pain. Tx if N1 or less--> chemoRT-->surgery
68
bev contraindications
cavitating tumor, SCC, hemoptysis, bleeding. relative: brain tumors (caution), anticoagulation (use caution)
69
brain mets therapy for NSCLC
isolated cerebral met: resect+WBRT, or SRS+WBRT if
70
alk fusion treatment
crizotinib, if progress, ceratinib
71
ROS1 translocation
can treat with crizotinib
72
BRAF in NSCLC
can respond to dabrafenib or +tremitinib
73
RET mutation
can respond to cabozantinib
74
MET abnl
can respond to crizotinib
75
treatment if pneumonectomy required
chemoRT. pneumonectomy inferior survival
76
PS2 chemotherapy
pem+carbo was better OS than pem alone. avoid cis
77
low dose CT scanning criteria
30pk*yr AND age 55-70. One time deal.
78
when is mediastinoscopy not needed
normal CT, normal PET
79
RT for small tumors
can give 60Gy in 30 Fx if not adequate PFTs, or SRS if
80
adjuvant chemo indications
stage IB consider, all with stage II-IIIA (if not chemoRT)

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